Note: Name and some details have been changed to maintain privacy
Years ago in Psychiatry residency, I met a patient with crystalline green eyes. I imagined they sparkled like jade in the sun and produced bioluminescence in the moonlight. Veiled behind dark brown hair, though, they barely caught the light streaming into my office. I watched my patient back into the couch, fold her legs under her like a rusty jackknife, and, between glances in my direction, stare at the floor, waiting for it to drop.
Let’s call her Lucia.
Every week, Lucia shrank into my faded floral sofa—a hand-me-down from the office manager who ran out of storage space—and waited with guarded expectation. She used as little space as possible. She behaved as if her words were an imposition on me and a sacrifice for her. Long stretches of silence trailed my questions. Under her breath, I heard: “You’re my last chance at happiness.” I didn’t know if she was speaking to me or surrendering herself to the universe, but once she said it, it became my charge.
I thought I was ready. I thought my years of psychiatric lectures and countless all-nighters at mental health wards had prepared me to treat the despondence swinging like sandbags on Lucia’s face. I hadn’t yet learned that even scholars are amateurs when maneuvering through others’ psyches and etched pain. That we can only hope to make a difference.
“How are you today?” I’d ask at the start of each session. I let her comfort guide us. She’d recount an argument with a coworker, maybe a hazy dream. I prodded her gently. Asked about her family.
“My mom disappeared for weeks when I was a kid,” Lucia whispered. “My boyfriends all cheated on me. Then left.” I learned of her childhood poverty, her absent father. Her physical abuse and emotional blackmail. Her enormous loneliness as an only child.
When I pressed her to expound upon her feelings, she changed the subject. Lucia offered me only the pointy tips of psychological icebergs, then waited, the bulk of her emotion pocketed in the hobo bag on her lap. I scaled the walls on tiptoe, slipping every time. She assessed me quietly as I scrambled and regrouped, hoping for the smallest of purchase in her icy terrain.
I understood she needed to test me. To see if I’d squash the delicate beating heart I was asking her to place in my hands. In therapy with traumatized patients, we hope for a slow emotional unraveling until the patient is ready to dissect and work through their pain. If I failed to build rapport, I knew she’d leave, possibly forever, imbued with the impression that therapy couldn’t assuage her suffering.
I tried every angle to make Lucia comfortable. I altered my tone of voice, pulled my chair around the desk, asked if she wanted music. I mixed up my therapy style, used different techniques, tried telling jokes. I told her she was in a safe place. That I wouldn’t hurt her. She smiled but continued to drop hulking tidbits about her life and retreat, as if we were playing tag and I was perpetually ‘It’. She always got away.
Sometimes I thought Lucia wanted me to dislike her. Other times, I thought she wanted me to fall in love. Neither happened. Her tests continued to assess her safety; my reassurances were never enough.
After a year, I reluctantly concluded our therapy had stalled. I’d failed her. In the gossamer moments after those words passed my lips, she asked the question she’d been cradling in her trembling hands the entire time: “When we’re not in here, do you ever think about…me?”
And there it was.
Lucia was asking if she mattered. Mattered to me. Not as a patient I was duty-bound to help, but as a person who warranted space in my thoughts when we were apart.
Lucia’s question probed at more than simple transference (a patient’s feelings towards their therapist based on past feelings about someone else) or countertransference (the therapist’s reaction to the patient and their transference). Suddenly, our one-sided relationship seemed so unfair. I knew more about her—her daydreams and her nightmares—than anyone she’d ever met. I knew her fears, her triumphs, her desires, her scars. Naturally, she wanted to know if I—not her psychiatrist, but me, the brown woman with the messy bun sitting across from her—thought about her in my private life, if she affected me as a person.
Lucia’s courage and my oversight stunned me. Especially since I had the same question. My residency program encouraged trainees to round out our education by undergoing therapy, so I’d been seeing a Jungian psychoanalyst who brought our therapeutic relationship into high focus.
Once a week, I walked down a long yellowing hallway in a formerly-statuesque but now crumbling hospital. The wallpaper peeled like burnt skin where the severed sheets met. Patient names were inscribed by fingernails in the drywall underneath. Ruby. Omar. Markus. Beth. Every time, I hesitated before entering my psychoanalyst’s low-lit office, knowing but not knowing what awaited me in the quiet light that seeped from the door’s gap.
My analyst’s office: a tasseled pillow rested at the head of a long paisley chaise lounge. Busts of psychoanalysts peppered the room, intermixed with framed Rorschach drawings. Lavender incense clung to the mantra-scribbled walls. From the middle of the room, he smiled at me (was he supposed to do that? What about professional stoicism?). He had a full head of prematurely white hair that looked like a Halloween wig.
After my long answers to his short questions, he left only pregnant pauses. When I asked what he thought, he redirected my questions back to me. I grew angry when he didn’t react to my grandmother’s death. I pulled back physically and emotionally. He picked up on my resistance (the crossed arms, the pressed lips) and insisted I call him out so we could “talk it through.”
It was an unnatural—nearly surreal—relationship, I remember thinking. Here was this middle-aged man who, if I’d met him in the real world, I’d never even divulge my aversion to celery. Now I was pouring out my deepest vulnerabilities as if he was the only human in the world who could meet even a fraction of my needs.
I dreamt about him often: wanting him to desire me, competing for his attention, him forgetting me. In some dreams, he was rugged and charming, his chest bulging with quivering muscles as he brandished a Montblanc pen; in others, he was weak and decrepit, with spindly arms and patches of white hair that fell like regurgitated hairballs from his stippled head. Sometimes I rescued him from his family (the one my mind conjured). Sometimes he floated in a large bidet, dead. We explored it all, making for incredibly uncomfortable sessions in which I spoke through clenched sphincters and teeth.
Many of his analyses were predictable (I saw him as a father figure, I was afraid of abandonment) but other revelations were subtle and built steadily upon each other. An accumulation of crossword puzzle answers that crescendoed into the last perfect letter. After many months of emotional frustration and reconsidering my career choice, I realized what most people walking past the office window could have told me within moments: I didn’t long for him. What I wanted was the hope that I mattered to him as more than just a patient. That he regarded me as more than a diagnosis. If I mattered to him—truly mattered as another human traversing the world alongside him—then I mattered to people in the ‘real world.’ And I know I’m not the only one who feels this.
Carl Jung, the Swiss psychiatrist who founded analytical psychology, coined the term “collective unconscious”—mankind’s inner experiences inherited from our species’ collective experience. Building upon the Greek roots arkhe- (primitive) and tupos (a model) which evolved into the Latin word archetype (prototype), Jung formulated his own definition of archetypes: universal themes and images derived from our collective unconscious to help understand our dreams and imagination.
In his 1933 book Modern Man In Search of a Soul, Jung wrote: “We should expect the doctor to have an influence on the patient in every effective psychic treatment; but this influence can only take place when he too is affected by the patient.”
Perhaps Lucia and I had both tapped into our Everyman archetype. We sought connection with others. We wanted to belong. I longed to influence my therapist just as Lucia longed to affect me.
The day my therapist told me he’d sat with my anger long after our session had ended—mulling it over, hoping I was okay, figuring out how to make amends—was beyond simply comforting. It was life-affirming. It changed our therapy; it changed me. He turned me away from Plato’s shadows on the cave wall towards the fire, towards the sun. He readjusted my perception of my mattering and ultimately, my reality.
But with Lucia, I’d missed it. While we worked on building her confidence, exploring painful experiences and finding closure, she was awaiting proof that I considered her more than her ‘issues.’ That she mattered to me.
Of course she did. On her birthday, I’d wonder if her mother remembered to call. If her boyfriend was kinder that day. I’d muse about what toppings she liked on her pizza. I’d grin as I rehashed the irreverent jokes she curated based on how much I laughed.
After my belated realization that she, too, needed my human connection alongside a therapeutic one, our relationship shifted.
“I mentally cheered for you during your job interview,” I said while we waited for the employer’s response. Her eyes shone.
“Your new Celtic tattoo illustrates your Irish history well.” She blushed, her cheeks ripe.
Over time, her posture gradually straightened, even while sitting in the sunken floral sofa. We’d discovered the keyhole to a massive iron door. I inserted the key, she turned it, and together we pressed our shoulders against it and pushed. Lucia’s therapy deepened. The emotion she’d long distanced from her experiences came rushing out, shrugging off all the rust and debris that had lined their telling.
Part of me wondered, “How could she have not known that she affected me? Hadn’t I shown her time and again that I was on her side, that she mattered deeply?” But a voice in me whispered back, “You didn’t know, either.” Touché.
One afternoon, after years of weekly meetings, Lucia declared she was moving to the East Coast. She’d decided to start a new life with the tools we’d put in her pocket. She ugly cried when she told me. I ugly cried back. “This room is a microcosm of the real world,” I told her as I roughly wiped my nose. “My feelings are reflected by the people out there.”
At the close of our last session, I gave her a tight hug, our first and our last. She was wearing heels. Not terribly high, but enough that I had to stand on my toes. Her hair smells like Pantene, I thought. Like mine. After she left, I thought about her regularly. Did she have rent money? Did her hard-won confidence still bloom? Were her jokes still irreverently hilarious?
I knew I wasn’t unique in thinking about my patients. Conversations with other psychiatrists and therapists mirrored my feelings. A colleague once told me about his seven-year-old patient with severe ADHD who’d been ‘returned’ by numerous foster parents. My colleague was the most stable adult in the boy’s life, and even then, only for ten months. That was years ago, and the boy remains in his thoughts. Was he ever adopted? Does he still hate cheese? He’ll never know.
We think about our patients while eating breakfast. We think about them long after therapy is over. We’ve spent the same number of hours with them as they have with us; their pain reaches across the room and grasps us in its clutch, too. For each time I let a tear fall in session, there are five times that I don’t. Not because I don’t feel or connect with my patients, but because my main task is to weigh the consequences of my response. My tears aren’t always helpful. But though our expressions are controlled, therapeutic constraints don’t bind our affection.
Several years after I last saw Lucia, I received a letter in my work mailbox. Her large cursive letters—blue ink bubbles on the creased envelope—made me hurry back to my office and tear it open. I could barely wait to see where life had taken her, or where she’d taken her life. After years of waiting tables and going to night school, she wrote, she was now kicking butt in corporate retail and making a hefty salary. She’d forgiven her mother. Her new boyfriend had introduced her to his parents. I smiled. That was a first.
She was writing because she’d dreamt about me the night before. In her dream, we were sitting at a café, sipping chai. I was dressed in maroon (had I told her that was my favorite color?) and was pregnant. In her dream, she thanked me for nurturing her. In her dream, I told her I hadn’t forgotten her. That I mentally cheered from afar.
As I read the words she’d written, I knew we both understood the weight that my pregnant image and her dream-words carried. She’d been my patient, yes, but in some ways, she’d also felt like my child. She’d finally felt seen and supported, important enough to take up residence in a part of my life. Her subconscious was offering her closure.
In Lucia’s dream, and in real life, she’d called upon her traumas to fuel a transformation from a withered peahen into a golden eagle, or an emerald hummingbird, or a resplendent quetzal. Frankly, she was all of these splendors all along, but it took feeling like she mattered in the world to allow her to flourish into a woman whose value was derived from within.
Even now, looking back, I still get misty thinking of the emotional and mental work she underwent. As her prior psychiatrist whom she invited to travel some distance with her on her journey, I am gratified and humbled. As the woman with the messy bun and my own issues who sat across from her all those years, I am awed and inspired. Lucia learned to believe she truly mattered to the people traversing the world with her. That our paths don’t exist in isolation. Whether in tiny offices or plein air fields where sunlight glints off emerald eyes, our worlds collide and coalesce and fragment and depart and return, if only in memories, if only in letters. But the most basic truth is that we matter to each other. Without words, without question.
Anita Vijayakumar was raised by her grandparents in India until moving to Chicago in her childhood. She obtained a Creative Writing degree before becoming a psychiatrist. She writes fiction, creative nonfiction, and poetry, and has recent or upcoming publications in Moon City Review, Barrelhouse, River Teeth, and others. Anita is completing a novel about betrayal, mental health and identity. Twitter: @AnitaV_K